点对点导向器在下胫腓联合分离准确定位置钉的初步临床应用

背景:AO组织推荐的下胫腓联合横向螺钉是目前治疗下胫腓联合分离的常用方法,然而该手术方法对术者经验要求较高和术中多次X线透视下完成,初学者需要经历较长的学习曲线。术中减少X线暴露、提高置钉准确和安全性、缩短初学者的学习曲线仍是临床医生所关切的问题。目的:自行设计研制一种点对点导向器,介绍其在下胫腓联合分离横向螺钉准确导向置钉的初步临床应用。方法:选择2011年7月至2012年11月下胫腓联合分离患者7例,以AO内固定原则为基础对踝关节及腓骨骨折解剖复位固定,下胫腓联合分离复位后利用自行研制的点对点导向器进行下胫腓联合横向螺钉导向置钉。结果:本组7例患者术后全部获得随访,随访时间6～15个月,平均(11.2±2.4)个月,患者踝关节功能恢复良好,按Baird-Jackson评分标准进行功能评价:优5例,良2例,可、差0例,优良率100%。结论:点对点导向器操作简便,可准确导向置钉,适用于下胫腓联合分离的固定。

Preliminary application of a point to point drilling guide for syndesmotic screw placement

Background： Transverse tibiofibular syndesmosis screw is recommended for distal tibiofibular diastasis by AO Organiza- tion. However, this surgical technique requires a experienced surgeon and repeated X-ray exposure to finish this procedure, and the learning curve is relatively long for the beginners. Reduce the X-ray exposure times,effectively improve the the syn- desmosis screw＇s placement accuracy and safety, and shortening the learning curve for the beginners are still the concerns of clinicians. Objective： To design a point to point drilling guide and introduce its preliminary clinical application in accurately syndesmo- sis screw placement guiding in distal tibiofibular diastasis. Methods： Seven patients with distal tibiofibular diastasis were chosen. Medial malleolus and fibula fractures were anatomi- cal reduction and internal fixation according to the AO principle. After the distal tibiofibular diastasis reduction, a point to point guiding apparatus was used to accurately place the syndesmosis screw. Results： All seven patients were followed-up post operation for 6 to 15 （11.2±2.4） months, with good ankle functional recov- ery. According to Baird-Jackson ankle function scoring criteria： excellent （5 patients）, good （5 patients）, fair or poor （no pa- tient）. The excellent and good rate was 100%. The preliminary results showed the point to point drilling guide can accurate- ly guide the syndesmosis screw placement. Conclusions： This point to point drilling guide was easy to operate, accurate syndesmosis screw placement guiding in distal tibiofibular diastasis, worth widely promoted in clinical practice.